A Difficult Differential Diagnosis in New Neck Masses: Retropharyngeal Abscess or Malignancy?

Retropharyngeal abscesses (RPAs) are rare in the adult population and rarer without an inciting event or comorbidity such as recent oral surgery, neck infection, or pharyngeal trauma. The definitive treatment is incision and drainage of the abscess. Clinical researchers have recently questioned whether invasive surgical intervention is necessary and posed the question of what role antibiotics play in management. Sequelae of RPAs are severe and include rupture of the abscess, erosion of the carotid artery, thrombophlebitis, and most seriously, airway compromise. We present a case where an atypical presentation of an RPA caused a disagreement among specialists, and the debate of whether the described case represented an abscess or malignancy caused a delay in diagnosis and treatment for the patient. Only after invasive and emergent surgical intervention was a final diagnosis able to be made. This case demonstrates the need for more research and official guidance on the management of new neck masses to hasten diagnosis and prevent devastating outcomes.

Roseomonas Species Bacteremia With Associated Endocarditis and Possible CNS Septic Embolic Phenomenon.

Rosemonas species has been associated with infections in both immunocompetent and immunocompromised hosts, manifesting as peritonitis, bacteremia, catheter-related bacteremia, endophthalmitis, spondylitis, and endocarditis. Here we present a man in his 60s who was brought to our institution for sudden onset of aphasia, right-sided paresthesia, and new onset tonic-clonic seizure episodes. At presentation, he was found to have severe lactic acidosis, acute kidney failure, bilateral hydronephrosis, elevated prostate-specific antigen (PSA), and an enlarged prostate. Blood cultures obtained on admission later grew Roseomonas species for which he was started on meropenem. A trans-esophageal echocardiogram (TEE) showed multiple very thin mobile densities on the ventricular side of the aortic valve; magnetic resonance imaging (MRI) of the brain revealed an 11 mm acute/subacute hemorrhage. The patient was discharged in stable condition on Ertapenem intravenous therapy for six weeks. Roseomonas mucosa can be a cause of endocarditis. The antimicrobial resistance profile of Roseomonas spp suggests that carbapenems, fluoroquinolones or aminoglycosides are the drugs of choice for Roseomonas infections and that infectious diseases involved in cases of Roseomonas infections should be instituted promptly for proper management.

The First Case of a Drug-Resistant Pasteurella multocida Prosthetic Knee Infection Successfully Treated With Debridement, Antibiotics, and Implant Retention.

Pasteurella multocida, a zoonotic infectious organism, has most often been described in patients after an animal bite. It can cause a variety of infections ranging from superficial skin infections to more serious systemic infections, such as sepsis and meningitis. P. multocida is a rare but well-recognized cause of prosthetic joint infections. Here, we report the first implant-associated infection caused by drug-resistant (penicillin, ampicillin, amoxicillin/clavulanic acid) P. multocida, which was cured with targeted antimicrobial treatment and debridement, exchange of mobile parts, and retention of the prosthesis. Patients undergoing arthroplasty should be informed of the risks of close contact with pets, especially in light of the worrying phenomena of drug resistance spreading among animals due to the addition of antibiotics in animal feed.

From Antibiotic Resistance to Antibiotic Renaissance: A New Era in Helicobacter pylori Treatment.

Helicobacter pylori (H. pylori) is a common bacterial infection that can cause gastric diseases, including gastric cancer. The standard treatment for H. pylori infection is a combination of antibiotics and acid suppressants, but antibiotic resistance has become a significant problem that can reduce treatment efficacy. The development of novel treatment strategies for H. pylori is necessary to reduce the burden of this infection on public health. This review article examines H. pylori antibiotic resistance and future treatment possibilities. We discuss transitioning from trial and error to antimicrobial stewardship and using multi-strain probiotics as an adjunct therapy for H. pylori eradication. This review article provides an extensive overview of H. pylori antibiotic resistance and future treatment possibilities. It begins with an introduction and background of the topic, followed by a literature review. The review of the literature covers the transition from trial and error to antimicrobial stewardship, the diagnosis and treatment of H. pylori, the comparative effectiveness of multiple first-line treatment regimens, the ideal H. pylori treatment for the present and future, the use of probiotics to reduce adverse events and improve eradication rates, and the use of novel and effective therapeutic regimens in an era of increasing antibiotic resistance. The conclusion summarizes the review's findings and provides recommendations for future research. The terms Helicobacter pylori, infection, antibiotic resistance, clarithromycin, macrolide resistance, proton pump inhibitors, vonoprazan, triple regimen, susceptibility, and stewardship were used in a PubMed literature search. Finally, the article highlights the urgent need for a global collaborative approach toward tackling antibiotic resistance in H. pylori infections.

A Patient With Fever, Loose Motions and Jaundice: Hickam's Dictum or Occam's Razor.

Infectious diseases like malaria, typhoid, leptospirosis, and dengue fever are the leading causes of morbidity and mortality in developing countries like Pakistan. Although rare, it is possible to have coinfection with organisms that are endemic in a region, causing diagnostic and therapeutic dilemmas. Leptospirosis is caused by Gram-negative spirochetes. Leptospira are widely distributed and are transmitted by contamination of water and food by the urine of infected animals like rodents. Leptospirosis is characterized by fever, body aches, abdominal pain, and hepatic and renal involvement. Laboratory abnormalities include cytopenia, elevated bilirubin, alanine aminotransferase, and abnormal renal function tests. Typhoid fever is caused by Salmonella typhi (S. typhi), which is transmitted by fecal contamination of drinking water and food items. The clinical manifestations of typhoid fever include fever, abdominal pain, and diarrhea. Laboratory abnormalities include cytopenia and mildly deranged liver function tests. A strain of S. typhi resistant to all antibiotics except azithromycin and carbapenems was isolated in 2016 in Pakistan. Most of the clinical manifestations and laboratory abnormalities of leptospirosis and typhoid fever overlap. There have been case reports of coinfection of S. typhi and Leptospira, but there is no report of coinfection of extensively drug-resistant (XDR) S. typhi and Leptospira. We present a case of a 20-year-old man with fever, loose motions, and jaundice from Peshawar, Pakistan who had coinfection of Leptospira and XDR S. typhi. The attending physicians should adopt Hickam's dictum instead of Occam's razor approach.

Helicobacter pylori Resistance to Triple Therapy in a Multicultural Population in New York City.

INTRODUCTION: Helicobacter pylori infection (HPI) has become a worldwide concern due to its associations with intestinal and extraintestinal disease including cancer, autoimmune phenomena, and vitamin deficiencies. HPI has been found to affect Hispanics at higher rates compared with non-Hispanics in the USA. Hispanics comprise most of the patient population at Metropolitan Hospital in New York City. Growing concerns about antibiotic resistance led to the reconciliation of treatment guidelines with the consensus of bismuth quadruple therapy as the first-line treatment, replacing clarithromycin-based triple therapy. We conducted a retrospective study to explore the resistance rate of Helicobacter pylori to triple therapy in patients at Metropolitan Hospital. OBJECTIVE: To explore the resistance rates of Helicobacter pylori in infected patients treated with clarithromycin-based triple therapy in Metropolitan Hospital over a five-year period. MATERIALS AND METHODS: Charts of all patients who underwent upper endoscopy during a five-year period were retrospectively reviewed. Overall, 2000 patients were screened for presence of HPI. We included 322 patients with a demonstrated HPI obtained from biopsies taken during upper endoscopy within the study period. Inclusion criteria were patients older than 18 years old with positive HPI who were prescribed therapy. Exclusion criteria were patients with positive HPI who did not receive treatment for the infection and patients without a confirmatory diagnosis of infection. We further reported on three groups based on the implemented therapy. Each treated group was divided into three subgroups based on eradication testing. Treatment compliance was documented. The patient population was demographically characterized by ethnicity, age at diagnosis, body mass index (BMI), and sex. RESULTS: Of the 322 patients included in the study, 258 were Hispanics (80%). The eradication rate among patients treated with selected clarithromycin-based therapies was found to be statistically significant when compared with other HPI therapies. There was no statistically significant difference between the studied group with respect to age, sex, ethnicity, and BMI. In the group of patients with suspected clarithromycin resistance, antimicrobial sensitivity testing was ordered in one case. DISCUSSION: HPI varies with race and ethnicity. Within the USA, the prevalence is lowest among non-Hispanics. Ethnicity and age, sex, and BMI were not factors that impacted treatment outcomes. We found that triple therapy with a proton pump inhibitor, amoxicillin, and clarithromycin (PAC) was used as a first-line treatment, consistently showing a low rate of resistance. The eradication rate among patients treated with PAC was found to be statistically significant when compared with all other therapies. It is significant for the hospitals with limited resources, where initial treatment follows the "test-and-treat" strategy. Quadruple therapy as the first-line treatment raises concerns about medication costs, insurance coverage, side effects, and dosing, which may have a significant impact on patient compliance. CONCLUSION: Our study showed that selected clarithromycin-based therapies were superior for HPI eradication when compared with non-clarithromycin-based triple therapy in low-resistance communities. Culture with antimicrobial susceptibility testing was used in a de minimis number of cases, which raises awareness for future study.